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Diagnosing ParkinsonsCurrent evidence suggests that Parkinsons tends to develop gradually and it may be many months,

even years, before the symptoms become obvious enough for you to seek medical advice.1

Confirming someone has Parkinsons can take some time as there are other conditions such as

essential tremor(see page 4), with similar symptoms. Also there are currently no definitive tests for

diagnosing Parkinson's. 2 The majority of people with Parkinsons are diagnosed by a specialistasking them about their symptoms and examining them. 3

This information sheet looks at what parkinsonism is, how Parkinsons and other similar conditions

may be diagnosed, and explains some of the tests that can be involved in the process.

What is parkinsonism?Parkinsonism is a term used to describe symptoms or signs that are found in Parkinsons but which

can also be found in other conditions that cause slowness of movement, stiffness and tremor.4

Most people with a form of parkinsonism have idiopathic Parkinsons disease, also known as

Parkinsons. Idiopathic means the cause is unknown.

Other less common forms of parkinsonism include multiple system

atrophy (MSA), progressive supranuclear palsy (PSP) and drug-induced parkinsonism.

Find out more: see our information sheet Parkinsonism and our leaflet,A quick introduction to

Parkinsons.Who should I speak to if I think I might have Parkinsons?

If you or your GP suspects you have Parkinsons, it is important you are referred to a Parkinsonsspecialist before any treatment is considered. It is not easy to diagnose the condition, so its

important that you see a Parkinsons specialist to get an accurate diagnosis.5

How is Parkinsons diagnosed?

Investigating symptoms

Parkinsons should be diagnosed after having a consultation with a specialist.5 A Parkinsons

specialist will take a detailed neurological interview and examination.3 Keeping a diary or record of

your symptoms may help in this process.

There are many different symptoms related to Parkinsons and these can vary from person to person.

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My GP told me I needed to see a neurologist and he told me he suspected Parkinsons. TheParkinsons specialist confirmed it and now I'm having treatment and feeling much better.Anne, diagnosed in 2009

Early symptoms may include a reduced sense of smell, vivid dreams and unusual movements duringdeep sleep (Rapid Eye Movement sleep behavioural disorder), constipation, weight loss, depression

and restless legs.

By the time that you talk to your specialist, typical symptoms of Parkinsons may include a tendency

to have small handwriting, slowness of movement (bradykinesia), tremor in the fingers, difficulty

turning over in bed and fatigue.6 Symptoms may also be made worse by stress or illness.

Looking for signs of Parkinsons

Your specialist will examine you to look for the presence of common or classical signs of

Parkinsons.6 You may be asked to:

write or draw - to see if your writing is small or gradually fades

walk - to see whether there is a reduction in the natural swing of your arm or in your stride length

and speed

speak - to see if your voice is soft or lacks volume

The specialist will also look at your:

face - to see if there is a masked look or if you have difficultly with facial expressions

limbs - to see if you have a tremor, any stiffness (rigidity) or slowness of movement (bradykinesia)

As well as examining you to look for any of the typical signs of Parkinsons,6 the specialist will also

look for any other signs that may indicate a different diagnosis7. This is because there are other

conditions that can cause similar symptoms to Parkinsons. These include essential tremor which is

described in more detail on page 4.

It may be helpful to take someone with you when seeing a specialist as they can be a support to you.

Taking a list of questions you want to ask can also be useful so you dont forget mention something

you want to know about.

Response to Parkinsons drugs

After examining you, your specialist may suggest you take medication for Parkinsons, as this can be

a way of testing if you definitely have the condition. If your symptoms improve after taking

Parkinsons medication for a few weeks or months, your specialist may confirm a Parkinsons

diagnosis. However, some people with other forms of parkinsonism will also respond well to these

drugs.6

Other medical tests or scans that may confirm a diagnosis of ParkinsonsYour specialist may suggest you have a scan to help make a diagnosis. None of these scans alone

can make a definite diagnosis of Parkinsons, so they are not commonly used.6

MRI or CT scans

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MRI or CT scans of the brain usually look normal in people with Parkinsonsbut can be helpful in

diagnosing the type of parkinsonism. The scan may look abnormal in some of the rarer forms.8

SPECT or DaTSCAN

A certain type of SPECT scan has become widely used for helping specialists confirm that there isdamage to particular brain cells, containing a chemical called dopamine.9 SPECT is a type of nuclear

imaging test that shows how blood flows to tissues and organs. This type of scan is known as a

dopamine transporter scan or DaTSCAN. Damage to these dopamine producing cells leads to the

stiffness and slowness of movement common in Parkinsons but similar damage may also occur in

some other rarer neurological conditions. So an abnormal DaTSCAN result cannot give a definitive

diagnosis of Parkinsons.

A normal DaTSCAN can be helpful in showing that a persons symptoms, particularly tremor, are not

the result of Parkinsons, but may result from another condition, for example, essential tremor10 (find

out more about essential tremor on page 4).

What is essential tremor?

A tremor is a rhythmical, involuntary movement that affects a part of the body, for example, the hand.

Essential tremor is the most common type of tremor. It is most noticeable when your hands are doing

something and it usually affects both right and left sides of the body equally. 11 Essential tremors often

lessen when your body is resting.

Unlike an essential tremor, a Parkinsons tremor is most obvious when the affected body part is at

rest and tends to be less noticeable with movement. It usually starts on one side of the body and may

progress to the other side as Parkinsons develops.12

My GP was reluctant to refer me in the beginning. Eventually, he wrote a letter to a specialist. Afterfour months, I had blood tests and an MRI scan. In all it took two years to get the diagnosis.Kris, diagnosed in 2004

How long will it take to get a confirmed diagnosis of Parkinsons?The time it takes to get a confirmed diagnosis can vary from person to person. Some people may

receive a diagnosis of Parkinsons quite quickly, but for others it may be a long process. This may be

due to a number of things, including your medical history, your age and what symptoms you have.

Your specialist may wish to rule out other causes for your symptoms first and see how you respond

to treatment. This may also take some time. And, as already mentioned, there is currently no

definitive test for Parkinsons.

Diagnosis is often made by observing the response to treatment. Keeping a diary or record of your

symptoms may help the specialist in their investigation.

If you are awaiting diagnosis and have any questions, you can call our helpline on 0808 800 0303.

You can also speak to others who are currently being diagnosed or have already gone through asimilar experience through our online discussion forum at parkinsons.org.uk/forum

Is it possible to be misdiagnosed?

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Because the symptoms of idiopathic Parkinsons may be similar to other forms of parkinsonism,

people can sometimes be misdiagnosed.7

It is difficult in the early stages to be certain what type of parkinsonism someone has as the response

to medication can be unclear. But as time goes on, depending on what symptoms you have, and your

response to Parkinsons medication, a specialist may be able to offer a more definite diagnosis.

As there is currently no definitive test for Parkinsons some experts prefer to use the term

parkinsonism. They may only use Parkinsons once the condition has been seen to follow a typical

course.

Will it be easier to diagnose Parkinsons more accurately in the future?Researchers are currently exploring new and different ways to diagnose and monitor Parkinsons

more accurately. These include looking at skin cells and blood samples to spot tiny but significant

changes, and developing new and more sensitive imaging techniques, such as ultrasound.

Other research areas include whether some of the very early symptoms of Parkinsons, such as

problems with sense of smell, can be detected using tests such as scratch and sniff tests and looking

for other chemical markers of the condition in the blood.

It's difficult to say how long it will be before new and better tests for diagnosing Parkinson's become

available, but research in this area is a major focus for Parkinson's UK.

More information and support

Parkinsons nursesParkinsons nurses provide expert advice and support to people with Parkinsons and those who care

for them. They can also act as a liaison between other health and social care professionals to make

sure your needs are met.

Parkinsons nurses may not be available in every area, but your GP or specialist can give you more

details on local services.

Information and support from Parkinsons UK

We produce a range of information resources about Parkinsons. You may want to read Parkinsons

and You our booklet for people who have been recently diagnosed.

See the back page for details of how to order.

You can call our free confidential helpline for general support and information. Call 0808 800 0303

(calls are free from UK landlines and most mobile networks) or email [email protected]

Our helpline can also put you in touch with one of our local information and support workers, who

provide one-to-one information and support to anyone affected by Parkinsons. They can also provide

links to local groups and services.

Our website has information about your local support team and how to contact them at

parkinsons.org.uk/localtoyou. You can find details of our local groups and your nearest meeting at

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mailto:[email protected]:[email protected]


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parkinsons.org.uk/localgroups. You can also visit parkinsons.org.uk/forum to speak with other

people in a similar situation on our online discussion forum.

Thank youThank you very much to everyone who contributed to or reviewed this information sheet:

Dr Richard Grunewald, Consultant Neurologist, Royal Hallamshire Hospital, Sheffield

Dr Peter Bain, Reader & Honorary Consultant in Clinical Neurology

Department of Clinical Neuroscience, London

Thanks also to our information review group and other people affected by Parkinsons who provided

feedback.

How to order our resources

01473 212115

[email protected]

parkinsons.org.uk/publications

We make every effort to make sure that our services provide up-to-date, unbiased and accurate

information. We hope that this will add to any professional advice you have had and will help you to

make any decisions you may face. Please do continue to talk to your health and social care team if

you are worried about any aspect of living with Parkinsons

Were the Parkinsons support and research charity. Help us find a cure and improve life for

everyone affected by Parkinsons.

Can you help?

At Parkinson's UK, we are totally dependent on donations from individuals and organisations to fund

the work that we do. There are many ways that you can help us to support people with Parkinson's. If

you would like to get involved, please contact our Supporter Services team on 020 7932 1303 or visit

our website at parkinsons.org.uk/support. Thank you.

Parkinsons UK

Free* confidential helpline 0808 800 0303

(Monday to Friday 9am8pm, Saturday

10am2pm). Interpreting available.

Text Relay 18001 0808 800 0303

(for textphone users only)

[email protected]

parkinsons.org.uk

*Calls are free from UK landlines and most

mobile networks.

FS48

Last updated April 2012. Next update available April 2014.

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Parkinsons UK, April 2012. Parkinsons UK is the operating name of the Parkinsons Disease

Society of the United Kingdom. A charity registered in England and Wales (258197) and in Scotland

(SC037554)

References

1 Wu Y, et al (2011) Preclinical Biomarkers of Parkinson Disease. 68(1) 22-30

2National Institute of Health & Clinical Excellence Parkinsons disease: National clinical guideline for diagnosis and

management in primary and secondary care (2006) p3

3 National Institute of Health & Clinical Excellence Parkinsons disease: National clinical guideline for diagnosis andmanagement in primary and secondary care (2006) p33

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MedlinePlus Medical Encyclopedia. Parkinsons Disease. Causeshttp://www.nlm.nih.gov/medlineplus/ency/article/000755.htm (accessed 16 March 2012)




8 National Institute of Health & Clinical Excellence Parkinsons disease: National clinical guideline for diagnosis and

management in primary and secondary care (2006) p42


10 MedlinePlus Medical Encyclopedia. Essential Tremor

http://www.nlm.nih.gov/medlineplus/ency/article/000762.htm (accessed 16 March 2012)

11 National Institute of Neurological Disorders and Stroke. Essential Tremor Information Page

http://www.ninds.nih.gov/disorders/tremor/tremor.htm (accessed 16 March 2012)

12 MedlinePlus Medical Encyclopedia. Parkinsons Disease. Symptoms

http://www.nlm.nih.gov/medlineplus/ency/article/000755.htm (accessed 16 March 2012)

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http://www.nlm.nih.gov/medlineplus/ency/article/000755.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000762.htmhttp://www.ninds.nih.gov/disorders/tremor/tremor.htmhttp://www.ninds.nih.gov/disorders/tremor/tremor.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000755.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000755.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000762.htmhttp://www.ninds.nih.gov/disorders/tremor/tremor.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000755.htm


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Diagnosing Parkinson's

If you have comments or suggestions about this information sheet, wed love to hear from you.

This will help us ensure that we are providing as good a service as possible.

Wed be very grateful if you could complete this form and return it to Resources and Diversity,

Parkinsons UK, 215 Vauxhall Bridge Road, London SW1V 1EJ. Or you can email us at

[email protected]. Thanks!

I have Parkinsons. When were ou dia nosed? ...

Im family/a friend/a carer of someone with Parkinsons

Im a rofessional workin with eo le with Parkinsons

Where did ou et this information sheet from?

GP, s ecialist or Parkinsons nurse Information and su ort worker

Parkinsons UK local rou or event Sharward Services

Our website Other

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If you would like to become a member of Parkinsons UK, or are interested in joining our

Information Review Group, please complete the details below and well be in touch.

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